TY - CHAP M1 - Book, Section TI - Diving Medicine and Near Drowning A1 - Piantadosi, Claude A. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. Y1 - 2023 N1 - T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSDrowning and near drowning are most common in young males; drugs and alcohol are frequently associated with such events.Underwater immersion is associated with increases in central blood volume and cardiac output, decreases in thoracic gas volume, and increases in urine output resulting in dehydration; vagally mediated bradycardia may also occur.Water inhalation (often with particulate matter) during drowning or near drowning may elicit laryngospasm, bronchospasm, surfactant depletion/dysfunction, aspiration of vomitus, and/or lung injury.Hypoxemia may culminate in bradycardia and pulseless electrical activity; global anoxic brain injury and acute tubular necrosis may also ensue.Controlled hypothermia (32°C to 34°C for at least 24 hours) may attenuate brain injury in drowning victims; corticosteroids and osmotic diuretics are not effective.33 feet depth in seawater (FSW) exerts one atmosphere of pressure; accordingly, at 33 FSW, a diver is at 2 atmospheres of pressure.Barotrauma may occur in any tissue location where gas is trapped in a closed space; the most common events occur in the middle ear, sinuses, and lungs.Pulmonary overpressurization usually occurs with ascent that is too rapid; this can lead to pneumothorax, pneumomediastinum, or arterial gas embolization (AGE); AGE leads to air entry into pulmonary veins and systemic dissemination. Treatment is prompt recompression with hyperbaric oxygen.Decompression sickness is caused by the formation of inert gas bubbles in the tissues after dissolved gas becomes supersaturated by a decrease in the ambient pressure. SN - PB - McGraw Hill CY - New York, NY Y2 - 2023/12/09 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201812979 ER -